Clinical ophthalmology (Auckland, N.Z.)最新文献

Purpose: To investigate the effect of 0.1% fluorometholone ophthalmic solution (FM) on intraocular pressure (IOP) in children after strabismus surgery.

Patients and methods: We included 224 eyes of 224 children aged <15 years who underwent strabismus surgery at JCHO Chukyo Hospital from January 2014 to December 2023, received FM four times daily in the operated eye for 1 month postoperatively, and underwent IOP measurement using a non-contact tonometer NT-530Ⓡ (NIDEK Co. Ltd. Aichi, Japan). We assessed pre- and postoperative IOPs, postoperative changes in IOP, the number of children with a postoperative increase of >6 mmHg in the IOP, and the number of children with a postoperative IOP >20 mmHg.

Results: The participants included 106 boys and 118 girls, with a mean age of 8.6 years. The mean pre- and postoperative IOPs were 14.7 ± 2.4 mmHg and 14.8 ± 3.3 mmHg, respectively, with no significant difference (p = 0.552). At 1 month postoperatively, 8 eyes (3.6%) had an increase of >6 mmHg, 14 eyes (6.3%) had a postoperative IOP >20 mmHg, and 3 eyes (1.3%) had both.

Conclusion: Short-term use of FM may not significantly increase IOP and may be considered safe for anti-inflammatory treatment in pediatric patients after strabismus surgery.

Purpose: To compare postoperative refractive error (PE) calculated using intraocular lens (IOL) calculation formulas based on initial and remeasured ocular parameters in cases of delayed cataract surgery.

Patients and methods: Patients who underwent delayed cataract surgery (ie, postponed for > 3 months) between February 2017 and April 2025 were included. Initial and remeasured ocular parameters were compared, namely axial length, mean keratometric power, anterior chamber depth (ACD), and lens thickness (LT). Expected refractions were calculated using the Sanders-Retzlaff-Kraff/Theoretical (SRK/T), Haigis, Barrett Universal II (BU II), Kane, and Emmetropia Verifying Optical (EVO) formulas. PEs were compared between the initial and remeasured data for each IOL calculation formula.

Results: The study included 57 eyes from 57 patients. Cataract surgery was delayed for an average of 14 months. Comparing the initial versus remeasured data, ACD deeper significantly and LT thinner significantly among the ocular parameters. The mean PE indicated a significant myopic shift for both the Haigis formula (0.02 D to -0.05 D) and EVO formula (0.00 D to -0.06 D) (paired t-test: p = 0.04, 0.03), while the other formulas had no significant differences. The mean absolute error and median absolute error showed no significant differences among the IOL calculation formulas. Based on the remeasured data, the results of the multiple regression analysis showed that only LT was a significant associated factor in the Haigis formula (estimate = 0.56, p = 0.02), whereas no significant associated factors were identified for the EVO formula.

Conclusion: It was suggested that the characteristics of each IOL calculation formula must be taken into consideration when selecting IOL power for delayed surgery.

Purpose: To evaluate the efficacy and safety of combining repeated low-level red light (RLRL) therapy with orthokeratology (OK) in slowing axial elongation in children with rapid myopia progression.

Patients and methods: This retrospective cohort included 72 children aged 8-14 years (RLRL+OK, n=36; OK-only, n=36) meeting the rapid-progressor definition (>0.40 mm/year axial elongation. One eye per child was randomly selected. Axial length (AL) was measured at baseline and at 3, 6, and 12 months. Inverse probability of treatment weighting (IPTW) based on age, sex, and baseline AL achieved good balance between groups. The primary outcome was the 12-month AL change, assessed using IPTW-weighted linear mixed-effects models adjusted for covariates. Prespecified subgroup analyses were stratified by age (<10 vs ≥10 years). Sensitivity analyses included propensity score matching (PSM), per-protocol analysis (PP; adherence ≥80%), and dose-response evaluation. Safety was assessed using slit-lamp biomicroscopy and macular OCT imaging.

Results: At 12 months, the RLRL+OK group had significantly less elongation than OK-only (mean difference -0.298 mm; 95% CI -0.388 to -0.209; p<0.001), with significant group×time interactions from 3 months. Benefits were consistent across age subgroups without effect modification. Sensitivity analyses confirmed robustness: PSM (-0.255 mm; p<0.001) and PP (-0.298 mm; p<0.001). Dose-response showed each 10% higher adherence reduced elongation by -0.148 mm (p<0.001). No clinically significant adverse events were detected.

Conclusion: RLRL combined with OK significantly reduced axial elongation in rapid-progressing children compared with OK alone, with a clear adherence-dependent effect and reassuring short-term safety profile.

Purpose: To quantify peripheral anterior synechiae (PAS) extent after Trabectome surgery using automated gonioscopy (GS-1) and its effects on intraocular pressure (IOP) reduction.

Patients and methods: This retrospective, single-center study included patients who underwent Trabectome surgery and were followed for ≥ 6 months. GS-1 was performed at 6 and 12 months postoperatively to quantify PAS as the proportion of the angle circumference. Analysis of covariance (ANCOVA; linear regression) was performed at 6 and 12 months postoperatively, with IOP reduction rate, PAS extent, and preoperative IOP as the dependent variable, independent variable, and covariate, respectively. The 6- and 12-month PAS extents were compared using the Wilcoxon signed-rank test. The correlations of 6- and 12-month IOP reduction rates with age, preoperative IOP, preoperative score, and PAS extent were determined using Spearman's rank coefficients.

Results: The data of 33 eyes (33 patients; 20 males; mean age, 68.5 ± 14.2 years) were analyzed. Trabectome surgery was performed as a standalone procedure for 28 patients and combined with cataract surgery for five. GS-1 revealed PAS in all eyes at 6 and 12 months. The mean PAS extents at 6 and 12 months were not significantly different at 40.16 ± 21.42% and 43.92 ± 20.68%, respectively (P = 0.286). Only preoperative IOP showed significant correlations with the 6- and 12-month IOP reduction rates (r = 0.641, 0.776; P = 0.002, < 0.001, respectively). ANCOVA revealed partial regression coefficients of 0.41 (P = 0.002) and 0.019 (P = 0.952) at 6 months and 0.37 (P = 0.014) and -0.180 (P = 0.623) at 12 months for preoperative IOP and PAS extent, respectively.

Conclusion: Widespread PAS was detected by GS-1 at 6 and 12 months postoperatively. However, its effect on postoperative IOP reduction and prognosis appears limited. Moreover, the long-term effects remain unclear; therefore, further studies are warranted.

Objective: This investigation sought to: (1) characterize anti-vascular endothelial growth factor (VEGF) therapy-induced choroidal structural modifications in center-involved diabetic macular edema (CI-DME) utilizing swept-source optical coherence tomography (SS-OCT) imaging, and (2) assess the predictive capacity of choroidal morphometric indices for visual functional prognosis.

Methods and analysis: This retrospective cohort study encompassed CI-DME patients received intravitreal anti-VEGF injections. Structural parameters, including retinal thickness, choroidal thickness, and choroidal vascularity index (CVI), were measured by SS-OCT pre- and post-treatment. Statistical evaluations included paired t-tests, Wilcoxon tests, Elastic Net regression, sensitivity analyses and prognostic analysis. Subgroup analysis was stratified by baseline characteristics.

Results: 58 eyes from 53 CI-DME patients were included. Following a single dose of anti-VEGF injection, logMAR BCVA improved significantly from 0.694 ± 0.342 to 0.614 ± 0.429 (P = 0.0103). Total choroidal volumes within the ETDRS grid decreased by 0.065 mm³ (P = 0.031). Retinal thickness significantly declined in all nine ETDRS subfields (P < 0.001), while choroidal thinning was most prominent in the central (mean deviation: -17.42 μm, P < 0.001), nasal inner ring (mean deviation: -15.10 μm, P = 0.0038), and nasal outer ring (mean deviation: -11.83 μm, P = 0.0249) regions. Elastic Net regression and sensitivity analyses identified changes in central retinal thickness and nasal outer ring choroidal thickness as key imaging biomarkers associated with BCVA gains. Prognostic analysis revealed that baseline nasal inner ring retinal thickness showed most association with post-treatment central retinal thickness, whereas visual acuity outcomes were closely linked to age and baseline temporal outer ring retinal thickness. Exploratory subgroup analyses demonstrated that eyes with thicker retinas and thinner choroids at baseline, as well as younger patients, appeared to receive more favorable ocular structural and visual responses.

Conclusion: SS-OCT imaging revealed region-specific changes of the retinal and choroidal thickness after anti-VEGF treatment, providing a practical reference for monitoring and tracking therapeutic response in CI-DME.

Purpose: To compare the refractive-prediction error (the difference between the predicted post-operative spherical equivalent and the actual spherical equivalent) of IOLMaster 700 and Sirius when their biometric data are fed into the Barrett Universal II formula.

Setting: Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China.

Design: Prospective, observational, single-center, paired-eye study.

Methods: 123 eyes of 93 cataract patients were enrolled. The participants ranged in age from 36 to 91 years, with a mean age of 65.38 ± 14.84 years. Axial length from IOLMaster 700 and corneal curvature, anterior-chamber depth and white-to-white from both devices were entered into the BarErett Universal II calculator to obtain predicted post-operative spherical equivalent (PRP). One week after uneventful phacoemulsification with monofocal intraocular lens implantation, manifest refraction provided the actual spherical equivalent (SE). Prediction error (ΔPRE = PRP - SE) and absolute error |ΔPRE| were primary outcomes.

Results: Both devices produced positive ΔPRE, but the median was lower for IOLMaster 700 than for Sirius (0.41 D vs 0.73 D; p < 0.05). Median |ΔPRE| was also smaller for IOLMaster 700 (0.61 D vs 0.80 D; p < 0.05). Eyes within ±0.50 D of target refraction numbered 45.5% for IOLMaster 700 versus 26.0% for Sirius (p < 0.05). Subgroup analysis showed no difference in error magnitude between long (AL > 25 mm) and normal axial-length eyes.

Conclusion: Under the Barrett Universal II formula, IOLMaster 700 yields more accurate refractive predictions than Sirius, with smaller systematic drift and absolute error, irrespective of axial length. Thus, IOLMaster 700 with Barrett Universal II is the preferred biometry for superior refractive accuracy. This study offers surgeons practical guidance for improving post-operative visual outcomes and patient satisfaction.

Dry eye disease (DED) is a growing global public health concern. The market for over-the-counter artificial tears, the mainstay treatment for DED, is also experiencing growth, driven by the rising prevalence of the condition and advancements in therapeutic formulations. The treatment landscape for DED is rapidly evolving, and currently marketed artificial tears vary in their active ingredients, use of preservatives, and formulations. Therefore, it is imperative to understand the breadth of management options and the evidence base of formulations to inform treatment decisions and treatment guidelines. In our narrative review, we provide an overview of the development and regulation of artificial tear formulations in the United States. We evaluate their active ingredients, formulations, and use of preservatives. Increasingly, preservative-free formulations are being developed that contain combinations of well-established active ingredients. In this context, a key focus of the narrative review is to critically analyze the novel, preservative-free, multidose formulation of hyaluronic acid and trehalose in artificial tears. We highlight its formulation and mechanism of action and its involvement in autophagy regulation and inflammatory response. We describe the strong and growing evidence base supporting the effectiveness and safety of this combination formulation of artificial tears in managing DED, and we also describe its use in postcataract surgery and in the real world.

Purpose: To evaluate the predictive accuracy of eight traditional and contemporary intraocular lens (IOL) power calculation formulas in Chinese cataract patients with prior radial keratotomy (RK).

Patients and methods: RK patients who underwent phacoemulsification with IOL implantation were retrospectively recruited. Refractive prediction errors (RPE)were calculated for eight formulas: Haigis-L, Shammas, Barrett True-K, Camellin Calossi Camellin (CCC), Kane, EVO, Pearl-DGS, and Jin-AI. The study compared RPE, mean absolute error (MAE), median absolute error (MedAE), and percentages of eyes achieving prediction errors within ±0.25, ±0.50, ±0.75, ±1.0, and ±2.0 diopters.

Results: This retrospective study analyzed 34 eyes from 21 patients with prior RK surgery. The superior performing IOL power calculation formulas were Jin-AI (MAE = 0.64 D, MedAE = 0.49 D), Barrett True-K (MAE = 0.58 D, MedAE = 0.535 D), and EVO (MAE=0.59 D, MedAE = 0.538 D). These three formulas demonstrated comparable accuracy, with 47.1%, 44.1%, and 44.1% of eyes achieving prediction errors within ±0.50 D, respectively. The Haigis-L and Pearl-DGS formulas exhibited significantly higher prediction errors in eyes with more than 12 RK incisions.

Conclusion: The Jin-AI, Barrett True-K, and EVO formulas demonstrated superior accuracy for IOL power calculation in Chinese cataract patients with prior RK. The Jin-AI formula, a novel artificial intelligence-based formula derived from Chinese individuals, presents a promising option for post-RK IOL calculation, while external validation studies across diverse ethnic groups are essential.

Purpose: To determine the contrast sensitivity (CS) and vision quality of patients with high and extreme high myopia following long-term evolution implantable collamer lens (EVO ICL) implantation.

Patients and methods: Thirty-five patients (60 eyes) with a myopia range of -7.25 D to -18.50 D were enrolled. Participants were categorized into the high myopia (HM) (spherical equivalent>-12.0 D) and extreme high myopia (EHM) (spherical equivalent≤-12.0 D) groups. Routine examinations, including measurements of endothelial cell density and anterior chamber parameters, were performed. CS and vision quality were assessed over a long-term follow-up period, with an average final follow-up time of 7.29±0.82 years.

Results: All surgical procedures were completed without any significant complications. No statistical differences for the CS parameters at the six different spatial frequencies in the corrected and uncorrected conditions were identified between the two groups (P>0.05). The vision quality questionnaire results indicated both groups reported concerns regarding the frequency of halos (HM group 57.6%, EHM group 63%). Driving was identified as the most distressing postoperative daily life activity. Further analysis revealed a negative correlation between driving distress and CS (B=-0.40, P<0.01). The preoperative axial length was found to be correlated with CS (B=-0.39, P<0.01).

Conclusion: Patients with HM and EHM maintained good long-term CS and vision quality after EVO ICL implantation. Halos and driving distress were the most common complaints.

Purpose: To evaluate the effects of rapid preoperative glycemic control on outcomes of cataract surgery for type 2 diabetes patients with high HbA1c levels.

Methods: The medical data of consecutive cohort patients with type 2 diabetes who underwent cataract surgery were respectively reviewed between January 2023 and May 2024. The rapid control group consisted of 152 patients (222 eyes) with HbA1c >9.0% following rapid glycemic control (average duration: 17.3 ± 6.6 days), and the basic control group consisted of 111 patients (162 eyes) with HbA1c <7.0%. Complications and visual outcomes were analyzed between the two groups during the 6-month postoperative follow-up.

Results: Macular edema and vitreous hemorrhage were the main postoperative complications in rapid control group (11.7%) and basic control group (4.9%) (P = 0.021). Linear Mixed-effects Models analysis showed that rapid glycemic correction (Odds ratio [OR] = 6.525, 95% confidence interval [CI] = 2.927-14.547, P < 0.001) and moderate to severe non-proliferative diabetic retinopathy (OR = 0.119, 95% CI = 0.054-0.263, P < 0.001) were the main risk factors of complications. However, only 3.8% of patients with timely intervention for diabetic retinopathy developed severe complications in rapid control group (P = 0.019). Besides, other complications including endophthalmitis, hyphema or incision leakage were not observed in rapid control group. At the final follow-up, the average best correction visual acuity in rapid control group was 0.30 ± 0.32 logMAR, with significant improvement compared with 1.26 ± 0.74 logMAR before surgery (P < 0.0001).

Conclusion: It seems to be unnecessary to prolong the duration of glycemic control before cataract surgery from safety and effectiveness. Timely intervention may prevent the severe complications of diabetic retinopathy after cataract surgery following rapid glycemic control.